CA-PAMR (Maternal Mortality Review)

Maternal mortality, or deaths from pregnancy-related causes, have been rising in the United States. The rate of maternal deaths in California in 1999 was 7.7 deaths per 100,000 live births and by 2006 it was 16.9 deaths per 100,000 live births. African-American women are roughly four times more likely to die from pregnancy-related causes than women in all other racial/ethnic groups.

In response to this concerning trend, the California Department of Public Health: Maternal, Child and Adolescent Health Division launched the California Pregnancy-Associated Mortality Review (CA-PAMR) project to identify pregnancy-related deaths, causation and contributing factors, and then make recommendations on quality improvements to maternity care. Since 2006, California has seen maternal mortality decline by 55 percent between 2006 to 2013, from 16.9 deaths per 100,000 live births to 7.3 deaths per 100,000 live births. In contrast, the U.S. national maternal mortality rate continued to rise.

Maternal Mortality Definitions

WHO Maternal Mortality:

Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

- Identified using “O-codes” on death certificates

- The Maternal Mortality Rate is calculated as the number of maternal deaths per 100,000 live births

- Used to measure trends and national/international comparisons

Pregnancy-Associated Deaths: The death of a woman during pregnancy or within one year of the end of pregnancy

- Used as the first step to identify pregnancy-related deaths

Pregnancy-Related Deaths: The death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy

- Used to identify QI opportunities and drive QI projects

Pregnancy-Associated but NOT Related Deaths: The death of a woman during pregnancy or within one year of the end of pregnancy from a cause that is not related to pregnancy

Funding Acknowledgement

CA-PAMR is supported by federal Title V Maternal and Child Health block grant from the California Maternal, Child and Adolescent Health Division of the California Department of Public Health.